Person-centred care to prevent hospitalisation - a focus group study with primary care providers

Abstract Background The primary healthcare sector comprises various health services, including disease prevention at local level. Research shows that targeted primary healthcare services can prevent the development of acute complications and reduce the risk of hospitalisations. While interdisciplinary collaboration has been suggested as a means to improve the quality and responsiveness of personal care needs in preventive services, effective implementation remains a challenge. The aim was to investigate perceptions of preventive care among primary healthcare providers by examining their views on what constitutes a need for hospitalisation, and which strategies are found useful to prevent hospitalisation. Further, to explain how interdisciplinary collaboration can be supported with a view to providing person-centred care. Methods Five focus group interviews were conducted with 27 primary healthcare providers. Interviews were transcribed, and analysed with qualitative content analysis. Results Three categories emerged: 1) Mental and social conditions influence physical functioning and hospitalisation need, 2) Well-established primary healthcare services are important to provide person-centred care through interdisciplinary collaboration and 3) Interdisciplinary collaboration in primary healthcare services is predominantly focussed on handling acute physical conditions. Conclusions By focusing on the whole person, it could be possible to provide more person-centred care through interdisciplinary collaboration and ultimately prevent some hospitalisations. The findings have clear implications for person-centred care and health system quality, and they highlight the need for involving stakeholders at all levels and for informing about the relevance of social and mental conditions, as they may influence the general health state and the risk of hospitalisation. The study supplements existing knowledge by providing valuable insight into the views of key primary healthcare providers. Key messages • Healthcare providers are attentive towards the influence of mental, social and physical conditions on the risk of hospitalisation highlighting the importance of care that considers the whole person. • The development and sustainable implementation of person-centred care in local primary care settings may be supported by evidence-based practices and co-production trajectories.


Background:
Colorectal cancer (CRC) is a critical public health issue in Central and Eastern European Countries, where it is the second leading cause of female cancer deaths. In this study, we aimed to identify the presence of CRC policies in EaP Countries and analyze the content of CRC policies for comprehensiveness.

Methods:
We conducted a scoping review based on the methodological framework suggested by Arksey and O'Malley. We searched for publicly-available policy documents from Armenia, Azerbaijan, Belarus, Georgia, Moldova and Ukraine. We outline each country's prevention approaches and activities based on World Health Organization (WHO) guidelines for CRC screening.

Results:
Most countries had at least one policy addressing some aspect of colorectal cancer prevention. Primary and secondary prevention were most commonly addressed, and certain details such as healthy lifestyle campaigns, target age and screening method (gFOBT, FIT or colonoscopy) were frequently mentioned in these policies. Policies to implement or pilot population-based CRC screening program have been adopted only by Georgia. Our analysis revealed the urgent need to improve the availability and use of colorectal cancer screening among those countries.

Conclusions:
These country experiences suggest that while prevention approaches can promote the best strategies to carry out screening programs, there is no standardized approach to screening for CRC.

Key messages:
Further research is urgently needed to better understand CRC screening needs of adults in EaP. Necessity of CRC screening irrespective of need will help make shift from curative to preventive cancer care.

Background:
The primary healthcare sector comprises various health services, including disease prevention at local level. Research shows that targeted primary healthcare services can prevent the development of acute complications and reduce the risk of hospitalisations. While interdisciplinary collaboration has been suggested as a means to improve the quality and responsiveness of personal care needs in preventive services, effective implementation remains a challenge. The aim was to investigate perceptions of preventive care among primary healthcare providers by examining their views on what constitutes a need for hospitalisation, and which strategies are found useful to prevent hospitalisation. Further, to explain how interdisciplinary collaboration can be supported with a view to providing person-centred care.

Methods:
Five focus group interviews were conducted with 27 primary healthcare providers. Interviews were transcribed, and analysed with qualitative content analysis.

Results:
Three categories emerged: 1) Mental and social conditions influence physical functioning and hospitalisation need, 2) Well-established primary healthcare services are important to provide person-centred care through interdisciplinary collaboration and 3) Interdisciplinary collaboration in primary healthcare services is predominantly focussed on handling acute physical conditions.

Conclusions:
By focusing on the whole person, it could be possible to provide more person-centred care through interdisciplinary collaboration and ultimately prevent some hospitalisations. The findings have clear implications for person-centred care and health system quality, and they highlight the need for involving stakeholders at all levels and for informing about the relevance of social and mental conditions, as they may influence the general health state and the risk of hospitalisation. The study supplements existing knowledge by providing valuable insight into the views of key primary healthcare providers.
Key messages: Healthcare providers are attentive towards the influence of mental, social and physical conditions on the risk of hospitalisation highlighting the importance of care that considers the whole person. The development and sustainable implementation of person-centred care in local primary care settings may be supported by evidence-based practices and co-production trajectories.

Background:
Antimicrobial resistance (AMR) is one of the major global public health threats that may lead to severe illness, hospital admissions, treatment failure and increasing of the health care costs. In order to address those challenges, the aims of this study were to examine the antibiotics consumption among the population of health care consumers in the Institute of Public Health of Belgrade, and their knowledge and attitudes regarding antibiotics compared to the inhabitants of EU and Japan.

Methods:
A cross-sectional study was conducted on a sample of 321 respondents who visited the Institute of Public Health of Belgrade in July 2021. The basic survey instrument was a Eurobarometer questionnaire (with the permission of the Directorate General for Communication European Commission). The obtained data were analyzed by methods of descriptive statistics, which included frequency distribution with percentages. In addition, the Chi-square test was used to examine the difference in frequencies.

Results:
More than half of all respondents used antibiotics in the previous 12 months (56.6%), majority of them with a doctor's prescription and 57.1% did some pre-testing (blood or urine test, swab) before or at the same time as using antibiotics. They used antibiotics most often for urinary infections (9,3%) and common cold (8,1%). We discovered that the knowledge of our respondents is somewhere in between comparing to the knowledge of the people from EU and Japan. 37.4% of our respondents knew that antibiotics are ineffective against cold and flu; 68.9% knew that unnecessary use of antibiotics makes them ineffective; 55.9% knew that taking antibiotics often leads to side effects such as diarrhea and 50.7% knew that antibiotics don't kill viruses.

Conclusions:
Knowledge about the antibiotics is insufficient and interventions of education, better informing and awareness of general public are necessary to encourage rational use of antibiotics.

Key messages:
It is important to take evidence based interventions to reduce unnecessary use of antibiotics. This is the first study about antibiotics in Serbia which used the Eurobarometer model of research. The COVID-19 pandemic has caused unprecedented challenges for populations, health systems and governments worldwide, which have resulted in lasting economic, social and health impacts. The results of such have been felt disproportionately throughout society and existing vulnerabilities have been highlighted and heightened. A clear understanding of the extent of these vulnerabilities is needed in order to fully address the problem. The World Health Organization Collaborating Centre on Investment for Health and Well-being (WHOCC), Public Health Wales has developed a summary report focusing on the existing and emerging inequalities resulting from the pandemic, as identified through international evidence and learning from the International Horizon Scanning Reports. These reports, undertaken between May 2020 -August 2021, are based upon rapid evidence synthesis reviews of international literature. The summary report focuses on global learning and best practices in order to better understand and address the unequal impacts of the pandemic. The information has been categorised according to the five essential conditions required to enable a healthy life as presented within the WHO health equity conditions framework. The report provides evidence on groups most vulnerable to both direct and indirect impacts of the pandemic as well as promising practice to address the resulting inequity. Inequalities and related factors explored within the report include but are not limited to, level of deprivation and education. Taking a global perspective, this report summarises international evidence to support inclusive, sustainable, and equitable solutions, such as protecting economic well-being and taking an intergenerational lens in both response and recovery. To address and mitigate the impact of the pandemic upon vulnerable groups, collating and sharing international evidence and best practice has proven to support equitable long-term socio-economic and environmental recovery.

Key messages:
International learning provides vital insights to support recovery in Wales and beyond.
Responses to the pandemic should address the needs of the vulnerable to reduce existing health gaps.